Basic USMLD Gyneco

1) A 29-year-old Caucasian primigravida patient is 20 weeks pregnant with twins. She found out today on her routine ultrasound for fetal anatomy that she is carrying two boys. In this patient’s case, which of the following statements about twinning is true?
The twins must be monozygotic since they are both males
If division of these twins occurred after formation of the embryonic disk, the twins will be conjoined
She has a higher incidence of having monozygotic twins since she is Caucasian
. If the ultrasound showed two separate placentas, the twins must be dizygotic
Twinning causes no appreciable increase in maternal morbidity and mortality over singleton pregnancies
2) A 24-year-old primigravida with twins presents for routine ultrasonography at 20 weeks gestation. Based on the ultrasound findings, the patient is diagnosed with dizygotic twins. Which of the following is true regarding the membranes and placentas of dizygotic twins?
They are dichorionic and monoamniotic only if the fetuses are of the same sex
. They are dichorionic and monoamniotic regardless of the sex of the fetuses
They are monochorionic and monoamniotic if they are conjoined twins
They are dichorionic and diamniotic regardless of the sex of the twins
They are monochorionic and diamniotic if they are of the same sex
3) After delivery of a term infant with Apgar scores of 2 at 1 minute and 7 at 5 minutes, you ask that umbilical cord blood be collected for pH. The umbilical arteries carry which of the following?
. Oxygenated blood to the placenta
. Oxygenated blood from the placenta
Deoxygenated blood to the placenta
. Deoxygenated blood from the placenta
Oxygenated blood from the placenta to mother
4) During the routine examination of the umbilical cord and placenta after a spontaneous vaginal delivery, you notice that the baby had only one umbilical artery. Which of the following is true regarding the finding of a single umbilical artery?
It is a very common finding and is insignificant
It is a rare finding in singleton pregnancies and is therefore not significant
. It is an indicator of an increased incidence of congenital anomalies of the fetus
. It is equally common in newborns of diabetic and nondiabetic mothers
It is present in 5% of all births
5) A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining of decreased fetal movement. She has had no prenatal care. On the fetal monitor there are no contractions. The fetal heart rate is 150 beats per minute and reactive. There are no decelerations in the fetal heart tracing. An ultrasound is performed in the radiology department and shows a 28-week fetus with normal-appearing anatomy and size consistent with dates. The placenta is implanted on the posterior uterine wall and its margin is well away from the cervix. A succenturiate lobe of the placenta is seen implanted low on the anterior wall of the uterus. Doppler flow studies indicate a blood vessel is traversing the cervix connecting the two lobes. This patient is most at risk for which of the following?
. Premature rupture of the membranes
Fetal exsanguination after rupture of the membranes
Torsion of the umbilical cord caused by velamentous insertion of the umbilical cord
Amniotic fluid embolism
Placenta accrete
6) A 27-year-old woman has used oral contraceptives (OCs) without problems for 5 years. However, she just read an article about complications of OCs in a popular women’s magazine and asks you about the risks and hazards of taking OCs. You correctly tell her which of the following?
The risk of developing ovarian cancer is increased
The risk of developing pelvic inflammatory disease (PID) is increased
The risk of developing endometrial cancer is decreased
The risk of bearing a child with major congenital anomalies is increased if taken while pregnant
The risk of ectopic pregnancy is increased
7) In an amenorrheic patient who has had pituitary ablation for a craniopharyngioma, which of the following regimens is most likely to result in an ovulatory cycle?
Clomiphene citrate
Pulsatile infusion of GnRH
. Continuous infusion of GnRH
Human menopausal or recombinant gonadotropin
Human menopausal or recombinant gonadotropin followed by human chorionic gonadotropin (hCG)
8) A 35-year-old African American woman presents to a physician complaining of irregular menstrual periods. She had her first menses at age 15 and states that her periods come irregularly every 2 to 6 months. She has been in a monogamous relationship with her husband for 15 years; for 10 years they have been trying unsuccessfully to conceive. She gets yearly Pap smears, which have been normal. Her height is 5 feet 2 inches (157.5 cm), and her weight is 200 pounds (90.9 kg). Her temperature is 37 C (98.6 F), blood pressure is 118/78 mm Hg, pulse is 80/min, and respirations are 14/min. She has acne, as well as excess hair, on her face and between her breasts. Her abdomen is obese. Examination is otherwise within normal limits. This patient is at greatest risk for developing which of the following diseases?
Cervical cancer
Endometrial cancer
Lung cancer
Osteoporosis
Ovarian cancer
9) An ovarian mass removed from a 49-year-old female has yellow coloration of its cut surface. The pathologist describes it as a granulosa-theca cell tumor. Based on this pathology report, the tumor is most likely to secrete?
Human chorionic gonadotropin
. Alpha-fetoprotein
. CA-125
Estrogen
. Cortisol
10) A 38-year-old Caucasian female presents to your office complaining of a small amount of vaginal discharge that appears following sexual intercourse. There is no associated abdominal pain or urinary symptoms. Her menstrual cycles occur with regular 28-day cycles; her last menstrual period was 2 weeks ago. She has never been pregnant. Menarche occurred at age 10, and she has been sexually active with 10 different partners over the last 20 years. She smokes two packs of cigarettes per day and consumes alcohol regularly. She admits that her diet is poor in vegetables and fruit. Her mother died of breast cancer at age 54, and her father, who is living, has hypertension. Cervical biopsy reveals cervical intraepithelial neoplasia III (CIN III). Which of the following is the strongest risk factor for this condition?
Early menarch
. Smoking
Alcohol consumption
Multiple sexual partners
. Nulliparity
11) A 19-year-old woman comes to the physician because of irregular vaginal bleeding. She has asthma and has never had surgery. She takes albuterol for her asthma and has been taking the oral contraceptive pill for 2 years. She has no allergies to medications. On examination she is found to have a vaginal lesion, which is biopsied. The biopsy shows clear cell adenocarcinoma of the vagina. This patient's malignancy is most likely associated with which of the following types of exposure?
Current albuterol use
Current oral contraceptive pill use
In utero aspirin exposure
In utero Coumadin exposure
In utero dietbylstilbestrol (DES) exposure
12) A 60-year-old postmenopausal woman presents with the new onset of uterine bleeding. An endometrial biopsy is diagnosed as atypical hyperplasia. Which of the following histologic changes is most characteristic of this abnormality?
. Crowding of endometrial glands with budding and epithelial atypia
Lymphatic invasion by interlacing bundles of atypical spindle-shaped cells
Menstrual-type endometrial glands with focal atypical cystic dilatation
. Secretory-type endometrial glands with hyperplasia of atypical polygonal cells having clear cytoplasm
Stromal invasion by malignant glands with focal areas of atypical squamous differentiation
13) Prolonged unopposed estrogen stimulation in an adult woman increases the risk of development of endometrial hyperplasia and subsequent carcinoma. Which of the following is the most common histologic appearance for this type of cancer?
. Adenocarcinoma .
Clear cell carcinoma
. Small cell carcinoma
. Squamous cell carcinoma
. Transitional cell carcinoma
14) A 46-year-old woman undergoes an abdominal hysterectomy for a “fibroid” uterus. The surgeon requests a frozen section on the tumor, which is deferred because of the lesion’s degree of cellularity. Which of the following histologic criteria will be used by the pathologist to determine if this tumor is benign or malignant?
. Mitotic rate
Cell pleomorphism
Cell necrosis
Nucleus-to-cytoplasm ratio
Tumor size
15) A 25-year-old woman presents to your office complaining of a seven-week history of amenorrhea. She also states that she has had nausea and vomiting for five weeks. She is sexually active. Her medical and obstetrical histories are unremarkable. Serum hCG level is elevated. Which of the following is the most important direct role of hCG in pregnancy?
Inhibition of uterine contractions
. Induction of prolactin production by the pituitary
Promotion and maintenance of implantation
. Maintenance of the corpus luteum
Induction of early embryonic division and differentiation
16) After reading an article titled: ''The Risk of Cancer in Patients with Diethylstilbestrol (DES) Exposed Mothers", a 23-year old female comes to your office with her mother for assessment of possible risks. Her mother had been given DES while pregnant. Which of the following cancers is this patient most at risk of developing?
. Vaginal squamous cell carcinoma
Rvical squamous cell carcinoma
Nocarcinoma of the endometrium
Adenocarcinoma of ovary
. Adenocarcinoma of vagina
17) A 32-year-old woman who presents with menometrorrhagia is found to have a 4.0-cm mass within her left ovary. This mass is resected surgically and a histologic section reveals the tumor to be composed of small polygonal cells growing sheets and anastomosing cords. Rare Call-Exner bodies are present. The tumor cells are found to stain positively with an immunoperoxidase stain against inhibin. Which one of the following is most likely to be secreted by these tumor cells?
Acid phosphatase
. α-Fetoprotein
. β-Human chorionic gonadotropin
. Estrogen
Testosterone
18) A 28-year-old nulliparous woman presents to your office complaining of fatigue, low mood, and amenorrhea. She says that it all started two months ago and progressively worsened. She is sexually active and uses condoms for contraception. Her medical history is unremarkable, and she denies taking any drugs or medications. Examination reveals dry skin, short eyebrows, a painless and enlarged thyroid gland, and galactorrhea. The uterus has a normal size, and the adnexae are not palpable. Initial investigations reveal the following: Serum pregnancy test: Negative; Free T4: 2.5 μg/dL (N= 5- 12); SerumTSH: 11.0 μU/ml (N= 0.5-5.0); Prolactin: 30 ng/ml (< 20 ng/ml); Antimicrosomal antibodies: Positive. Of the following, which represents the association between hypothyroidism and hyperprolactinemia in the above patient?
TRH stimulates prolactin production
. TRH stimulates dopamine production
. TSH inhibits dopamine production .
. TSH stimulates dopamine production
Antimicrosomal antibodies stimulate dopamine production
19) A 39-year-old woman presents with increasing abdominal distention and pelvic pain. A CT scan finds a slight amount of fluid in the pleural cavity and also a 3.5cm tumor of the right ovary. The tumor is resected and histologic sections reveal the tumor to be composed of spindle-shaped cells. These cells did not stain with an oil red O special stain. Which of the following types of ovarian tumor is most likely to produce this constellation of findings?
. Epithelial tumor
. Stromal tumor
. Germ cell tumor
. Surface tumor
. Metastatic tumo
20) During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?
. Stress
. Primary hyperthyroidism
. Anorexia nervosa
. Congenital adrenal hyperplasia
. Polycystic ovarian disease
21) A 36-year-old morbidly obese woman presents to your office for evaluation of irregular, heavy menses. An office endometrial biopsy shows complex hyperplasia of the endometrium without atypia. The hyperplasia is most likely related to the excess formation in the patient’s adipose tissue of which of the following hormones?
. Estriol
. Estradiol
. Estrone
. Androstenedione
. Dehydroepiandrosterone
22) A 29-year-old woman, gravida 2, para 0, comes for a routine prenatal visit. According to her history, she is at 16-weeks gestation. She had a first trimester miscarriage during her previous pregnancy. She does not take any vitamin supplementation. Vital signs are stable and physical examination is unremarkable. Initial laboratory studies show increased maternal serum alpha-fetoprotein (MSAFP) levels. Which of the following is the most likely cause of the abnormal laboratory finding?
. Neural tube defect
. Edward syndrome
. Down syndrome
. Omphalocele
. Gestational age error
23) A 39-year-old patient is contemplating discontinuing birth control pills in order to conceive. She is concerned about her fertility at this age, and inquires about when she can anticipate resumption of normal menses. You counsel her that by 3 months after discontinuation of birth control pills, what proportion of patients will resume normal menses?
. 99%
. 95%
. 80%
. 50%
. 5%
24) A 32-year-old woman presents to your office to discuss contraception. She has recently stopped breast-feeding her 8-month-old son and wants to stop her progestin-only pill because her cycles are irregular on it. You recommend a combination pill to help regulate her cycle. You also mention that with estrogen added, the contraceptive efficacy is also higher. In combination birth control pills, which of the following is the primary contraceptive effect of the estrogenic component?
Conversion of ethinyl estradiol to mestranol
. Atrophy of the endometrium
. Suppression of cervical mucus secretion
. Suppression of luteinizing hormone (LH) secretion
. Suppression of follicle-stimulating hormone (FSH) secretion
25) A 22-year-old woman presents to your office for her well-woman examination and contraception. She has no medical problems or prior surgeries. She does not smoke or drink. Her vital signs and physical examination are normal. You explain the risks and benefits of combination oral contraceptive pills to the patient. She wants to know how they will keep her from getting pregnant. Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin?
. Direct inhibition of oocyte maturation
. Inhibition of ovulation
. Production of uterine secretions that are toxic to developing embryos
. Impairment of implantation hyperplastic changes of the endometrium
. Impairment of sperm transport caused by uterotubal obstruction
26) Five patients present for contraceptive counseling, each requesting that an IUD be inserted. Which of the following is a recognized contraindication to the insertion of an IUD?
. Pelvic inflammatory disease
. Previous pregnancy with an IUD
. Dysfunctional uterine bleeding
. Cervical conization
. Chorioamnionitis in previous pregnancy
27) A 30-year-old woman presents to your office for her well-woman examination and contraception. She has two prior vaginal deliveries without any complications. Her medical and surgical histories are negative. Her family history is significant for coronary heart disease in her father and breast cancer in her mother diagnosed at the age of 62 years. In addition to effective contraception, health benefits for women taking oral combination contraceptives include which of the following?
. Decreased risk of lung cancerx
. Decreased incidence of benign breast disease
. Decreased diastolic hypertension
. Decreased risk of cervical cancer
. Decreased incidence of thromboembolism
28) A couple presents to your office to discuss permanent sterilization. They have three children and are sure they do not want any more. You discuss the risk and benefits of surgical sterilization. Which of the following statements is true regarding surgical sterilizations?
They cannot be performed immediately postpartum
. They have become the second most common method of contraception for white couples between 20 and 40 years of age in the United States
They can be considered effective immediately in females (bilateral tubal ligation)
. They can be considered effective immediately in males (vasectomy
. Tubal ligation should be performed in the secretory phase of the menstrual cycle
29) A 32-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the physician for a prenatal visit. She has no current complaints. Her past medical history is significant for hepatitis C infection, which she acquired through a needle stick injury at work as a nurse. She is hepatitis B and HIV negative. She takes no medications and has no allergies to medications. Her prenatal course has been uncomplicated. She wants to know whether she can have contact with the baby or breast-feed given her hepatitis C status. Which of the following is the correct response?
There is no evidence that breast-feeding increases HCV transmission
There is strong evidence that breast-feeding increases HCV transmission
Complete isolation is not needed but breast-feeding is prohibited
. The patient should be completely isolated from the baby
Casual contact with the baby is prohibited
30) The shortest distance between the sacral promontory and the symphysis pubis is called which of the following?
. Interspinous diameter
. True conjugate
. Diagonal conjugate
. Obstetric (OB) conjugate
. Biparietal diameter
31) A patient presents in labor at term. Clinical pelvimetry is performed. She has an oval-shaped pelvis with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter. The baby is occiput posterior. The patient most likely has what kind of pelvis?
. A gynecoid pelvis
An android pelvis
. An anthropoid pelvis
. A platypelloid pelvis
. An androgenous pelvis
32) On pelvic examination of a patient in labor at 34 weeks, the patient is noted to be 6 cm dilated, completely effaced with the fetal nose and mouth palpable. The chin is pointing toward the maternal left hip. This is an example of which of the following?
. Transverse lie
Mentum transverse position
. Occiput transverse position
Brow presentation
. Vertex presentation
33) A 34-year-old primigravida develops severe postpartum bleeding requiring aggressive volume resuscitation and transfusion of 5 units of packed red blood cells. Her pregnancy was complicated by mild hypertension and trace proteinuria that was treated with low-dose methyldopa. Her mother suffered from premature menopause and severe osteoporosis. Seven days after giving birth, she has failed to lactate. Her urinalysis is insignificant and her blood pressure has ranged from 95 to110 mmHg systolic and 69 to 75 mmHg diastolic. Fundoscopy shows no retinal changes. Which of the following is most likely deficient in this patient?
. Inhibin
. Progesterone
. Aldosterone
Prolactin
Oxytocin
34) A 28-year-old nulliparous woman is being evaluated for infertility. She has no other medical problems. Pelvic examination reveals abundant mucus and a clear cervical secretion, which when lifted vertically extends in a long thread; pH is 6.5. This visit took place at which of the following phases of the menstrual cycle?
. Early follicular phase
Ovulatory phase
Mid luteal phase
. Late luteal phase
The secretion is abnormal
35) A 32-year-old poorly controlled diabetic G2P1 is undergoing amniocentesis at 38 weeks for fetal lung maturity prior to having a repeat cesarean section. Which of the following laboratory tests results on the amniotic fluid would best indicate that the fetal lungs are mature?
Phosphatidylglycerol is absent
. Lecithin/sphingomyelin ratio of 1:1
Lecithin/sphingomyelin ratio of 1.5:1
. Lecithin/sphingomyelin ratio of 2.0:1
Phosphatidylglycerol is present
36) A wealthy executive donates five million dollars for the prevention of intrauterine growth restriction in the local county. Spending this money on which of the following programs would prevent the greatest number of cases of fetal growth restriction (FGR) in the population?
Alcoholic anonymous
. Smoking cessation
. Malnutrition prevention
. Hypertension control
. Infection control
37) Your patient is a healthy 28-year-old G2P1001 at 20 weeks gestational age. Two years ago, she vaginally delivered at term a healthy baby boy weighing 6 lb 8 oz. This pregnancy, she had a prepregnancy weight of 130 lb. She is 5ft 4 in tall. She now weighs 140 lb and is extremely nervous that she is gaining too much weight. She is worried that the baby will be too big and require her to have a cesarean section. What is the best counsel for this patient?
. Her weight gain is excessive, and she needs to be referred for nutritional counseling to slow down her rate of weight gain
. Her weight gain is excessive, and you recommend that she undergo early glucola screening to rule out gestational diabetes
She is gaining weight at a less than normal rate, and, with her history of a smallfor-gestational-age baby, she should supplement her diet with extra calories
During the pregnancy, she should consume an additional 300 kcal/day versus prepregnancy, and her weight gain so far is appropriate for her gestational age
During the pregnancy she should consume an additional 600 kcal/day versus prepregnancy, and her weight gain is appropriate for her gestational age
38) A 28-year-old woman at 39 weeks gestation is admitted to the hospital. She has regular uterine contractions. Her blood pressure is 120/70mmHg, pulse is 80/min and respirations are 18/min. Fetal heart monitoring is placed and shows a baseline rate of 130 beats/min, without any associated abnormalities. Pelvic examination shows the cervix is 50% effaced and 3 cm dilated. Amniotomy is performed. Immediately after the rupture of membranes, the baseline fetal heart rate increases to 160 beats/min and then drops to 70 beats/min with repetitive late decelerations. There is severe acute vaginal bleeding. Repeat vital signs of the patient shows a blood pressure of 130/70mmHg, pulse of 80/min and respirations of 18/min. Which of the following is the most likely cause of the current condition?
Premature separation of the placenta
Abnormal placental implantation
. Ruptured fetal umbilical vessel
Excessive amniotic fluid
Tear in uterine musculature
39) A 62-year-old postmenopausal woman was found to have right adnexal enlargement on pelvic examination 2 weeks ago. Transabdominal and transvaginal ultrasounds revealed a 5-cm, unilocular, right ovarian mass with regular borders. There is no ascites. The patient went through menopause at age 52. She has had no postmenopausal spotting. There is no family history of ovarian or breast cancer. Her latest mammogram 2 months ago showed no abnormalities. Which of the following is the most appropriate course of action?
. Cancer antigen 125 level
Combination chemotherapy
. Needle aspiration for cytology
Repeated vaginal ultrasonography in 6-8 weeks
. Surgical removal
40) A 28-year-old nulliparous woman is being evaluated for infertility. She has no other medical problems. Pelvic examination reveals abundant mucous and a clear cervical secretion, which when lifted vertically extends in a long thread; pH is 6.5. This visit took place at which of the following phases of the menstrual cycle?
Early follicular phase
. Ovulatory phase
Mid luteal phase
. Late luteal phase
The secretion is abnormal
41) A 21-year-old nulligravid woman comes to her physician to discuss birth control options. She became sexually active for the first time 2 weeks ago. She is currently using condoms for contraception. Her past medical history is significant for asthma, which has been inactive for 2 years. She takes no medications and has no allergies to medications. She has no family history of cancer. Her examination is within normal limits. After a discussion with the physician, she chooses to take the oral contraceptive pill (OCP). She stays on the pill for the next 6 years. She now has most significantly decreased her risk of developing which of the following malignancies?
Breast cancer
Cervical cancer
Liver cancer
Lung cancer
Ovarian cancer
42) A 33-year-old, gravida 3, para 3 woman comes to the physician because of amenorrhea of 9-month duration. She denies symptoms of any kind. She had a tubal ligation after the birth of her last child 2 years ago. She did not breast feed. Her menarche was at the age of 13 years, and her menses were regular until 18 months ago. At that time, her menses skipped every other month, and then they stopped. She currently takes no medication. She weighs 120.2 kg (264lb) and is 160 cm (5'3") tall. Initial physical examination shows no abnormalities except for morbid obesity. In the initial blood work, serum TSH and prolactin levels are within normal limits. Follow-up laboratory test show: FSH 20 mIU/mL (normal: 5-30 mIU/mL), LH 15 mIU/mL (normal: 5-20 mIU/mL). Which of the following is the most likely explanation for this patient's amenorrhea?
. Anovulation
Normal menopause
Pituitary dysfunction
. Post tubal ligation syndrome
. Premature ovarian failure (primary ovarian insufficiency)
43) An 18-year-old G2P1001 with the first day of her last menstrual period of May 7 presents for her first OB visit at 10 weeks. What is this patient’s estimated date of delivery?
. February 10 of the next year
February 14 of the next year
. December 10 of the same year
December 14 of the same year
December 21of the same year
44) A 45-year-old white female has undergone a right mastectomy for a node-negative, estrogen and progesterone receptor-positive tumor. She is scheduled to begin adjuvant therapy with tamoxifen. Her menstrual cycles are regular and her last menstrual period was 15 days ago. She has many concerns about tamoxifen therapy and would like to know its risks and benefits. Which of the following is she at risk for?
Osteoporosis
Vaginal candidiasis
. Endometrial cancer
Ovarian cancer
Ischemic optic neuropathy
45) A 14-year-old girl s brought to the physician's office because of irregular menstrual periods. She had her menarche at age 13, and since then her periods have been irregular with the cycles varying from 3 to 6 weeks. She has no other symptoms. Physical examination is unremarkable. She has age appropriate secondary sexual characters. A urine pregnancy test is negative. Serum prolactin and thyroid stimulating hormone levels are normal. Administration of micronized oral progesterone results in withdrawal bleeding in 3 days. Which of the following most likely explains her irregular periods?
. Marked estrogen deficiency
Insufficient gonadotropin secretion
Excess LH secretion
Marked androgen excess
. Uterine adhesions
46) A 26-year-old woman comes to the physician for follow-up after a recent spontaneous abortion at 14 weeks gestation. She had one other spontaneous first trimester abortion two years ago. She has no other medical problems and does not use tobacco, alcohol or drugs. Review of systems reveals photosensitivity and occasional hematuria. On examination, you observe a bilateral malar rash. What is the most likely pathophysiology for her abortions?
Lupus anticoagulant
Vasospasm
Chromosomal abnormalities
Disseminated intravascular coagulation
Congenital heart block
47) A 27-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a prenatal visit. She has no complaints. Her obstetric history is significant for a primary low transverse cesarean delivery because of a non-reassuring fetal tracing 3 years ago. She has no medical problems. She takes prenatal vitamins and has no known drug allergies. She is debating whether to have an elective repeat cesarean delivery or to attempt a vaginal birth after cesarean (VBAC). She wants to know her chances for a successful VBAC. Which of the following most accurately represents the patient's likelihood of having a successful vaginal delivery?
. 0% .
25%
. . 50%
. 70%
100%
48) A 29-year-old patient comes to the physician for an annual examination. She has normal menstrual periods every 30 days. She was 15 years old when she first began having intercourse. She uses condoms for contraception. Her past medical history is significant for multiple sclerosis. This condition has required her to use a wheelchair for the past 4 years, which makes pelvic examination somewhat difficult for her. She smokes one pack of cigarettes per day. Given her difficulty with the pelvic examination, she inquires as to how often she needs to have a Pap smear performed. Which of the following is the correct answer?
. A Pap smear should be performed every year
A Pap smear should be performed every 3 years
. A Pap smear should be performed every 5 years
A Pap smear should be performed only if there are symptoms
. A Pap smear is not necessary
49) A 33-year-old woman comes to the physician for her first prenatal visit. Her last menstrual period was 7 weeks ago. She has had no bleeding or abdominal pain. She has no medical problems and takes no medications. She has no family history of congenital anomalies. Her husband is 55 years old. He is in good health and also has no family history of birth defects. The patient is concerned that her husband's age may place their fetus at increased risk of a chromosomal anomaly. She wishes to know the paternal age above which amniocentesis or chorionic villus sampling should be considered. Which of the following is the correct response?
Above age 30 .
. Above age 35
. Above age 40
. Above age 45
There is no age cut off for paternal risk
50) A 44-year-old woman, gravida 4, para 3, at 8 weeks' gestation comes to the physician for her first prenatal visit. She has mild nausea and vomiting but no other complaints. Her obstetric history is significant for three full-term, normal vaginal deliveries of normal infants. She has no medical or surgical history and takes no medications. Physical examination reveals an 8-week-sized uterus, but is otherwise unremarkable. She wishes to have chromosomal testing of the fetus and wants to have chorionic villus sampling performed, as she did with her last pregnancy. Compared with amniocentesis, chorionic villus sampling may place the patient at greater risk for which of the following?
Fetal Down syndrome
. Fetal limb defects
. Fetal neural tube defects
. Maternal sepsis
. Mid-second-trimester abortion
51) A maternal fetal medicine specialist is consulted and performs an in-depth sonogram on a 30-year-old G1 at 28 weeks with a twin gestation. The sonogram indicates that the fetuses are both male, and the placenta appears to be diamniotic and monochorionic. Twin B is noted to have oligohydramnios and to be much smaller than twin A. Which of the following would be a finding most likely associated with twin A?
. Congestive heart failure .
. Anemia
. Hypovolemia
Hypotension
. Low amniotic fluid level
52) A 40-year-old G2P1001 presents to your office for a routine OB visit at 30 weeks gestational age. Her first pregnancy was delivered 10 years ago and was uncomplicated. She had a normal vaginal delivery at 40 weeks and the baby weighed 7 lb. During this present pregnancy, she has not had any complications, and she reports no significant medical history. She is a nonsmoker and has gained about 25 lb to date. Despite being of advanced maternal age, she declined any screening or diagnostic testing for Down syndrome. Her blood pressure range has been 100 to 120/60 to 70. During her examination, you note that her fundal height measures only 25 cm. Which of the following is a likely explanation for this 1270 patient’s decreased fundal height?
. Multiple gestation
. Hydramnios
. Fetal growth restriction
. The presence of fibroid tumors in the uterus
. Large ovarian mass
53) A 38-year-old G4P3 at 33 weeks gestation is noted to have a fundal height of 29 cm on routine obstetrical visit. An ultrasound is performed by the maternal-fetal medicine specialist. The estimated fetal weight is determined to be in the fifth percentile for the estimated gestational age. The biparietal diameter and abdominal circumference are concordant in size. Which of the following is associated with symmetric growth restriction?
Nutritional deficiencies
. Chromosome abnormalities
. Hypertension
. Uteroplacental insufficiency
. Gestational diabetes
54) A 37-year-old G4P2 presents to your office for new OB visit at 8 weeks. In a prior pregnancy, the fetus had multiple congenital anomalies consistent with trisomy 18, and the baby died shortly after birth. The mother is worried that the current pregnancy will end the same way, and she wants testing performed to see whether this baby is affected. Which of the following can be used for chromosome analysis of the fetus?
. Biophysical profile
. Chorionic villus sampling
. Fetal umbilical Doppler velocimetry
. Maternal serum screen
. Nuchal translucency
55) A 21-year-old G0 woman presents for a well-woman examination. Menarche began at age 12 years, and her periods occur every 26–30 days and last 4–5 days. She has had two sexual partners since becoming sexually active last year. She uses condoms for contraception and denies a history of sexually transmitted disease. Her physical examination is within normal limits. She has never had a pelvic exam before, and asks why it is necessary for her to get a Pap smear. Which of the following statements about cervical cancer screening is true?
A patient whose cytology shows atypical squamous cells of undetermined significance and who is 1271 human papillomavirus negative should have repeat cytology in 12 months
A patient whose cytology shows high-grade squamous intraepithelial lesions should be tested for human papillomavirus status
Cervical cancer screening should be started at the time of first reported sexual activity, but no later than age 21 years
Cervical cancer screening should be started only after a patient first reports sexual act
Women >30 years old who have had three normal smears should be screened every 3years indefinitely
56) During routine breast examination of a 28-year-old woman with no significant family or past medical history, a firm 2-cm mass is detected in the patient’s right breast. It is freely mobile and non-tender. Ultrasound reveals a solid, well-circumscribed mass, which is later found to be benign by biopsy. Which of the following statements is true?
There is an increased incidence of this tumor in Japanese women
There is an increased incidence of this tumor in women undergoing tamoxifen therapy
There is an increased risk of cancer in both breasts with this condition
There is no increased risk for this tumor in women with BRCA-1 mutations
This tumor may increase in size during pregnancy
57) Labor and vaginal delivery occur successfully in a 29-year-old woman after administration of oxytocin (Pitocin) for 9 hours. Spontaneous onset of labor at term is the result of which of the following?
Cortisol production in the amniotic cavity
Prostaglandin release from the fetal membrances
Prolactin produced in the decidua
Fetal pituitary secretion of oxytocin from the neurohypophysis
Events that are currently uncertain
58) A 28-year-old woman with 28-day menstrual cycle is attempting to conceive and is considering the use of a home ovulation predictor kit to time intercourse at ovulation. She asks you what day of her menstrual cycle her luteinizing hormone (LH) peak is most likely to occur. What should you tell her?
Day 12
Day 14
day 18
Day 20
Day 20
59) An 11-year-old girl has her first menses. Both ovaries contain approximately how many oocytes?
7 million
1 million
500,000
50,000
5000
60) A healthy 29-year-old gravida 2 woman at 39 weeks has been in labor for 3 hours. She had a positive vaginal-anal culture for GBS at 37 weeks’ gestation. Which one of the following statements is correct?
Asymptomatic rectovaginal colonization is present in 60% of pregnant women.
The transmission rate from mother to baby is approximately 25%.
A rectovaginal culture should have been obtained at the first prenatal visit.
Neonatal sepsis occurs in 1% of colonized mothers
Treatment with penicillin in labor is necessary only for heavy colonized mothers.
61) A 17-year-old woman, gravida 1, para 0, at 38 weeks' gestation comes to the labor and delivery ward because of contractions. Her dating was determined by a 7-week ultrasound. Her prenatal course was complicated by gestational diabetes. Her past surgical history is significant for shoulder surgery. She takes insulin and prenatal vitamins. She has no known drug allergies. She smokes 3-4 cigarettes per day. She is initially found to be 4 cm dilated and is contracting every 2-3 minutes. She is admitted to the labor and delivery ward and, over the next 4 hours, progresses to full dilation. After pushing for 2 hours, she delivers the fetal head but has great difficulty delivering the fetal shoulders. Eventually, the fetus is delivered by the posterior arm. In the process of delivery of the newborn's humerus is fractured. Which of the following factors contributed the most to the difficult delivery of the fetus?
Cigarette smoking
Gestational age
Gestational diabete
Maternal age
Maternal shoulder surgery
62) A 28-year-old nulliparous woman presents to your office complaining of fatigue, low mood, and amenorrhea. She says that it all started two months ago and progressively worsened. She is sexually active and uses condoms for contraception. Her medical history is unremarkable, and she denies taking any drugs or medications. Examination reveals dry skin, short eyebrows, a painless and enlarged thyroid 1273 gland, and galactorrhea. The uterus has a normal size, and the adnexae are not palpable. Initial investigations reveal the following: Serum pregnancy test: Negative, Free T4: 2.5 μg/dl (N= 5-12), Serum TSH: 11 .0 μU/ml (N= 0.5-5.0), Prolactin: 30 ng/ml (< 20 ng/ml). Antimicrosomal antibodies: Positive of the following, which represents the association between hypothyroidism and hyperprolactinemia in the above patient?
. TRH stimulates prolactin production
TRH stimulates dopamine production
. TRH stimulates dopamine production
TSH stimulates dopamine production
. Antimicrosomal antibodies inhibits dopamine production
63) A 51-year-old woman comes to your office for a routine health maintenance examination. She has no medical history but states that she has been having irregular menses and occasional hot flashes for the past eight months. Her husband has told her that she appears moody all the time. She has not had any surgeries in the past and currently takes no medications. She has a very stressful job and drinks two to three cups of coffee every morning. She does not smoke, but she does drink four to five twelve-ounce beers a day for the past 20 years to relieve her stress. She is a lacto-ovo vegetarian and walks two miles on a treadmill each day. Her temperature is 36.5C (97.7F), blood pressure is 120/70, heart rate is 84 beats/minute, and respirations are 12/minute. She is 5'4" and weighs 180 pounds (BMI is 30.9 kg/m2). Physical examination is unremarkable. You inform her that she is probably reaching menopause, and that she will be at an increased risk of developing osteoporosis. Which of the following is the most significant risk factor for the development of osteoporosis in this patient?
. Caffeine use .
. Obesity
. Excess alcohol use
Vegetarian diet
. Excess walking
64) A 25-year-old woman comes to the physician with abdominal bloating, headache, fatigue, weight gain, anxiety, and decreased libido. She experiences these symptoms intermittently in 7 to 10-day episodes. In retrospect, she is unable to identify any triggers for her symptoms. The patient has a history of postpartum depression but has no recent feelings of hopelessness or guilt Physical examination is normal. Complete blood count, serum chemistries, and thyroid-stimulating hormone levels are within normal limits. Which of the following is the most appropriate next step in management of this patient?
. Alprazolam
. Cognitive behavioral therapy
. Fluoxetine
. Gluten-free diet
. Menstrual diary
65) A 25-year-old woman presents to your office complaining of a seven-week history of amenorrhea. She also states that she has had nausea and vomiting for five weeks. She is sexually active. Her medical and obstetrical histories are unremarkable. Serum hCG level is elevated. Which of the following is the most important role of hCG in pregnancy?
. Inhibition of uterine contractions
Induction of prolactin production by the pituitary
. Promotion and maintenance of implantation
Maintenance of the corpus luteum
Induction of early embryonic division and differentiation
66) Your patient delivers a 7-lb 0-oz male infant at term. On physical examination, the baby has normal-appearing male external genitalia. However, the scrotum is empty. No testes are palpable in the inguinal canals. At 6 months of age the boy’s testes still have not descended. A pelvic ultrasound shows the testes in the pelvis, and there appears to be a uterus present as well. The presence of a uterus in an otherwise phenotypically normal male is owing to which of the following?
. Lack of Müllerian-inhibiting factor
. Lack of testosterone
. Increased levels of estrogens
. 46, XX karyotype
Presence of ovarian tissue early in embryonic development
67) A 20-year-old female with Müllerian agenesis is undergoing laparoscopic appendectomy by a general surgeon. You are consulted intraoperatively because the surgeon sees several lesions in the pelvis suspicious for endometriosis. You should tell the surgeon which of the following?
. Endometriosis cannot occur in patients with Müllerian agenesis since they do not have a uterus
Endometriosis is common in women with Müllerian agenesis since they have menstrual outflow obstruction
. Endometriosis probably occurs in patients with Müllerian agenesis as a result of retrograde menstruation
. Endometriosis may arise in patients with Müllerian agenesis as a result of coelomic metaplasia
. Endometriosis cannot occur in patients with Müllerian agenesis because they have a 46, XY karyotype
68) A 19-year-old patient presents to your office with primary amenorrhea. She has normal breast and pubic hair development, but the uterus and vagina are absent. Diagnostic possibilities include which of the following?
XYY syndrome
. Gonadal dysgenesis
. Müllerian agenesis
. Klinefelter syndrome
. Turner syndrome
69) Which of the following pubertal events in girls is not estrogen dependent?
. Menses
Vaginal cornification
Hair growth
Reaching adult height
. Production of cervical mucus
70) A 9-year-old girl has breast and pubic hair development. Evaluation demonstrates a pubertal response to a GnRH-stimulation test and a prominent increase in luteinizing hormone (LH) pulses during sleep. These findings are characteristic of patients with which of the following?
. Theca cell tumors
. Iatrogenic sexual precocity
. Premature thelarche
Granulosa cell tumors
Constitutional precocious puberty
71) You suspect that your infertility patient has an inadequate luteal phase. She should undergo an endometrial biopsy on which day of her menstrual cycle?
. Day 3 .
. Day 8
. Day 14
Day 21
Day 26
72) You have recommended a postcoital test for your patient as part of her evaluation for infertility. She and her spouse should have sexual intercourse on which day of her menstrual cycle as part of postcoital testing?
Day 3
. Day 8
. Day 14
. Day 21
. Day 26
73) You ask a patient to call your office during her next menstrual cycle to schedule a hysterosalpingogram as part of her infertility evaluation. Which day of the menstrual cycle is best for performing the hysterosalpingogram?
Day 3
. Day 8
. Day 14
. Day 21
. Day 26
74) You have recommended that your infertility patient return to your office during her next menstrual cycle to have her serum progesterone level checked. Which is the best day of the menstrual cycle to check her progesterone level if you are trying to confirm ovulation?
. Day 3
. Day 8
. Day 14
. Day 21
. Day 26
75) Your patient is 43 years old and is concerned that she may be too close to menopause to get pregnant. You recommend that her gonadotropin levels be tested. Which is the best day of the menstrual cycle to check gonadotropin levels in this situation?
. Day 3
. Day 8
. Day 14
Day 21
.. Day 26
76) A 28-year-old woman comes to your office for an annual visit. She has been in good health over the past year. She exercises regularly and watches her diet. She has hypothyroidism for which she takes thyroid hormone replacement. She has no other medical problems. She had an appendectomy at the age of 18 and has had no other surgeries. She takes no other medications and has no known drug allergies. Physical examination, including breast and pelvic exam, is normal. She has three children and does not wish to become pregnant again. She has tried the oral contraceptive pill and the intrauterine device (IUD), but stopped both of these methods because of side effects. She is now considering tubal ligation. Counseling of this patient should include the fact that if she does have a tubal ligation she will be at increased risk for which of the following conditions?
. Intrauterine pregnancy
Menstrual dysfunction
. Ovarian cancer
. Pelvic inflammatory disease
. Regret
77) A 56-year-old woman presents to your office for her routine wellwoman examination. She had a hysterectomy at age 44 for symptomatic uterine fibroids. She entered menopause at age 54 based on menopausal symptoms and an elevated FSH level. She started taking estrogen replacement therapy at that time for relief of her symptoms. She is fasting and would like to have her lipid panel checked while she is in the office today. You counsel the patient on the effects of estrogen therapy on her lipid panel. She should expect which of the following?
An increase in her LDL
An increase in her HDL
. An increase in her tota cholesterol
. A decrease in her triglycerides .
. A decrease in her HD
78) A 65-year-old woman presents to your office for evaluation of genital prolapse. She has a history of chronic hypertension, well controlled with a calcium channel blocker. She has had three full-term spontaneous vaginal deliveries. The last baby weighed 9 lb and required forceps to deliver the head. She says she had a large tear in the vagina involving the rectum during the last delivery. She has a history of chronic constipation and often uses a laxative to help her have a bowel movement. She has smoked for more than 30 years and has a smoker’s cough. She entered menopause at age 52 but has never taken hormone replacement therapy. Which of the following factors is least important in the subsequent development of genital prolapse in this patient?
Chronic cough
. Chronic constipation
. Chronic hypertension
. Childbirth trauma
. Menopause
79) A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding vertical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the vertical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. Which of the following represents the approximate risk of vertical transmission (from the mother to the fetus) for this patient?
. 2%
. 8%
. 25%
. 50%
. 100%
80) A 36-year-old woman, gravida 5, para 4, at 30 weeks' gestation comes to the physician for a prenatal visit. She feels the baby moving and has not had bleeding per vagina, contractions, or loss of fluid. The prenatal course has been uncomplicated thus far. The patient is interested in having a postpartum tubal ligation. She has many questions regarding the procedure, including whether there is a risk of failure. Which of the following represents the closest estimate for the likelihood of failure of a postpartum tubal ligation?
1 in 10.
. 1 in 100
. 1 in 1000
1 in 1,000,000
. There are no reported failures of postpartum tubal ligation.
81) A 23-year-old primigravid woman at 29-weeks' gestation comes to the physician because of contractions. She states that they have been occurring every 3-5 minutes for the past few hours and that they are worsening in intensity. Examination reveals that the patient is afebrile and her abdomen is nontender. Her cervix is 3 cm dilated, and the fetus is in vertex position. The patient is started on IV 1279 magnesium sulfate and penicillin and given an intramuscular injection of betamethasone. Which of the following represents the most significant consequence of this patient's preterm labor?
. Cesarean delivery
. Forceps assisted vaginal delivery
. Maternal infection
. Neonatal prematurity
Shoulder dystocia
82) A 22-year-old G1 at 14 weeks gestation presents to your office with a history of recent exposure to her 3-year-old nephew who had a rubella viral infection. In which time period does maternal infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?
Preconception
. First trimester
. Second trimester
Third trimester
. Postpartum
83) A 22-year-old has just been diagnosed with toxoplasmosis. You try to determine what her risk factors were. The highest risk association is which of the following?
Eating raw meat .
. Eating raw fish
. Owning a dog
English nationality
. . Having viral infections in early pregnancy
84) A 30-year-old class D diabetic is concerned about pregnancy. She can be assured that which of the following risks is the same for her as for the general population ?
Preedampsia
Infection
Fetal cystic fibrosis
Postpartum hemorrhage after vaginal delivery
Hydramnios
85) A 37-year-old G3P2 presents to your office for her first OB visit at 10 weeks gestation. She has a 1280 history of Graves’ disease and has been maintained on propylthiouracil (PTU) as treatment for her hyperthyroidism. She is currently euthyroid but asks you if her condition poses any problems for the pregnancy. Which of the following statements should be included in your counseling session with the patient?
. She may need to discontinue the use of the thionamide drug because it is commonly associated with leukopenia.
Infants born to mothers on PTU who are euthyroid may develop a goiter and be clinically hypothyroid.
. Propylthiouracil does not cross the placenta
Pregnant hyperthyroid women, even when appropriately treated, have an increased risk of developing preeclampsia.
. Thyroid storm is a common complication in pregnant women with Graves disease
86) A 23-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of contractions. She states they are occurring every 4 to 8 minutes and each lasts approximately 1 minute. She reports good fetal movement and denies any leakage of fluid or vaginal bleeding. The nurse places an external tocometer and fetal monitor and reports that the patient is having contractions every 2 to 10 minutes. The nurse states that the contractions are mild to palpation. On examination the cervix is 2 cm dilated, 50% effaced, and the vertex is at −1 station. The patient had the same cervical examination in your office last week. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. Which of the following stages of labor is this patient in?
. Active labor
. Latent labor
. False labor
. Stage 1 of labor
. Stage 2 of labor
87) A 38-year-old G3P3 begins to breast-feed her 5-day-old infant. The baby latches on appropriately and begins to suckle. In the mother, which of the following is a response to suckling?
. Decrease of oxytoc
. Increase of prolactin-inhibiting factor
Increase of hypothalamic dopamine
Increase of hypothalamic prolactin
. Increase of luteinizing hormone-releasing factor
88) A 26-year-old G1P1 is now postoperative day (POD) 6 after a low transverse cesarean delivery for arrest of active phase. On POD 2, the patient developed a fever of 39C (102.2F) and was noted to have 1281 uterine tenderness and foul-smelling lochia. She was started on broad-spectrum antibiotic coverage for endometritis. The patient states she feels fine now and wants to go home, but continues to spike fevers each evening. Her lung, breast, and cardiac examinations are normal. Her abdomen is nontender with firm, nontender uterus below the umbilicus. On pelvic examination her uterus is appropriately enlarged, but nontender. The adnexa are nontender without masses. Her lochia is normal. Her white blood cell count is 12 with a normal differential. Blood, sputum, and urine cultures are all negative for growth after 3 days. Her chest x-ray is negative. Which of the following statements is true regarding this patient’s condition?
. It usually involves both the iliofemoral and ovarian veins
Antimicrobial therapy is usually ineffective.
Fever spikes are rare
Heparin therapy is always needed for resolution of fever
. Vena caval thrombosis may accompany either ovarian or iliofemoral thrombophlebitis
89) A 32-year-old G2P2 develops fever and uterine tenderness 2 days after cesarean delivery for nonreassuring fetal heart tones. She is placed on intravenous penicillin and gentamicin for her infection. After 48 hours of antibiotics she remains febrile, and on examination she continues to have uterine tenderness. Which of the following bacteria is resistant to these antibiotics and is most likely to be responsible for this woman’s infection?
Proteus mirabilis
. Escherichia coli
Bacteroides fragilis
α-Streptococci
Anaerobic streptococci
90) A patient was induced for being postterm at 421/2 weeks. Immediately following the delivery, you examine the baby with the pediatricians and note the following on physical examination: a small amount of cartilage in the earlobe, occasional creases over the anterior two-thirds of the soles of the feet, 4-mm breast nodule diameter, fine and fuzzy scalp hair, and a scrotum with some but not extensive rugae. Based on this physical examination, what is the approximate gestational age of this male infant?
. 28 weeks
. 33 weeks
. 36 weeks
. 38 weeks
. 42 weeks
91) A 30-year-old G3P3 is postoperative day 4 after a repeat cesarean delivery. During the surgery she 1282 received 2 units of packed red blood cells for a hemorrhage related to uterine atony. She is to be discharged home today. She complains of some yellowish drainage from her incision and redness that just started earlier in the day. She states that she feels feverish. She is breast-feeding. Her past medical history is significant for type 2 diabetes mellitus and chronic hypertension. She weighs 110 kg. Her vital signs are temperature 37.8C (100.1F), pulse 69 beats per minute, respiratory rate 18 breaths per minute, and blood pressure is 143/92 mm Hg. Breast, lung, and cardiac examinations are normal. Her midline vertical skin incision is erythematous and has a foul-smelling purulent discharge from the lower segment of the wound. It is tender to touch. The uterine fundus is not tender. Which of the following is not a risk factor for her condition?
Diabetes
. Corticosteroid therapy
. Preoperative antibiotic administration .
Anemia
. Obesity
92) A 44-year-old G6P3215 presents for her well-woman examination. She tells you that all of her deliveries were vaginal and that her largest child weighed 2900 g at birth. How many full-term pregnancies did this patient have?
1
2
3
5
5
93) A 30-year-woman presents to your office with the fear of developing ovarian cancer. Her 70-year-old grandmother recently died from ovarian cancer. You discuss with her the risks factors and prevention for ovarian cancer. Which of the following can decrease a woman’s risk of ovarian cancer?
. Use of combination oral contraceptive therapy
Menopause after age 55
Nonsteroidal anti-inflammatory drugs
. Nulliparity
Ovulation induction medications
94) Which of the following statements is true regarding contraception?
The vaginal contraceptive ring is changed weekly for 3 consecutive weeks, then removed for 1 week to allow for withdrawal bleeding.
Because of effects on the cytochrome P450 system, Depo-Provera should not be used in patients taking antiepileptic drugs (e.g., phenytoin)
Amenorrhea while using the levonorgestrel intrauterine system (IUD) should raise concern immediately for ectopic pregnancy
A diaphragm should be inserted no more than 6 hours before intercourse and should remain in place about 6 hours after intercourse
Failure rate for tubal ligation over 10 years is less than 1 pregnancy per 1000 surgeries performed.
95) A 31-year-old primigravida develops gestational diabetes mellitus and is managed appropriately during pregnancy. She asks you about the consequences of gestational diabetes to her and her fetus. Which one of the following statements is correct?
The risk of fetal anomalies is increased.
The risk of stillbirth is increased if her fasting blood sugars are elevated
The risk of a growth-restricted newbornis increased
Insulin is the preferred treatment to maintain euglycemia.
The risk of fetal macrosomia is not increased with gestational diabetes
96) A 23-year-old G1P0010 woman complains of severe dysmenorrhea (i.e., pain with menses). She misses work for the first 3 days of her menstrual cycle almost every month and states that this has been a problem for about 3 years, now getting worse. She is not currently sexually active and is not using any hormonal contraception. She complains of occasional deep abdominal pain after bowel movements. Subsequent laparoscopic evaluation reveals endometriosis. Which of the following is a true statement regarding this condition?
Smoking is a strong risk factor for the development of endometriosis.
There is a direct relationship between perceived pain and the amount of endometriosis noted at the time of surgery.
Most women with endometriosis also have infertility.
Medical and surgical management are equally effective in restoring fertility in the patient with endometriosis.
The most common sites of endometriosis implants are the ovaries and anterior and posterior cul-de-sacs
97) A 21-year-old woman presents with left lower quadrant pain. An anterior 7-cm firm adnexal cyst is palpated. Ultrasound confirms a complex left adnexal mass with solid components that appear to contain bone and teeth. What percentage of these tumors are bilateral?
. Less than 1%
. 2% to 3%
. 10% to 15%
. 50%
. Greater than 75%
98) A patient is receiving external beam radiation for treatment of metastatic endometrial cancer. The treatment field includes the entire pelvis. Which of the following tissues within this radiation field is the most radiosensitive?
. Vagina
. Ovary
. Rectovaginal septum
. Bladder
. Rectum
99) A pregnant 35-year-old patient is at highest risk for the concurrent development of which of the following malignancies?
. Cervix .
. Ovary
. Breast
. Vagina
Colon
100) A 17-year-old girl is seen by her primary care physician for the evaluation of left lower quadrant pain. The physician felt a pelvic mass on physical examination and ordered a pelvic ultrasound. You are consulted because an ovarian neoplasm is identified by the ultrasound. Which of the following is the most common ovarian tumor in this type of patient?
. Germ cell
Papillary serous epithelial
. Fibrosarcoma
.. Brenner tumor
. Sarcoma botryoides
101) A 41-year-old woman undergoes exploratory laparotomy for a persistent adnexal mass. Frozen section diagnosis is serous carcinoma. Assuming that the other ovary is grossly normal, what is the 1285 likelihood that the contralateral ovary is involved in this malignancy?
. 5% .
. 15% .
33%
.. 50% .
75%
102) A 21-year-old woman returns to your office for evaluation of an abnormal Pap smear. The Pap smear showed a squamous abnormality suggestive of a high-grade squamous intraepithelial lesion (HGSIL). Colposcopy confirms the presence of a cervical lesion consistent with severe cervical dysplasia (CIN III). Which of the following human papilloma virus (HPV) types is most often associated with this type of lesion?
HPV type 6
. HPV type 11
. HPV type 16
. HPV type 42
. HPV type 44
103) One day after a casual sexual encounter with a bisexual man recently diagnosed as antibody-positive for human immunodeficiency virus (HIV), a patient is concerned about whether she may have become infected. A negative antibody titer is obtained. To test for seroconversion, when is the earliest you should reschedule repeat antibody testing after the sexual encounter?
. 1 to 2 weeks
. 3 to 4 weeks
. 4 to 10 weeks
12 to 15 weeks .
. 26 to 52 weeks
104) After reading an article titled: "The Risk of Cancer in Patients with Diethylstilbestrol (DES) Exposed Mothers", a 23-year old female comes to your office with her mother for assessment of possible risks. Her mother had been given DES while pregnant. Which of the following cancers is this patient most at risk of developing?
. Vaginal squamous cell carcinoma
. Cervical squamous cell carcinoma
. Adenocarcinoma of the endometrium
. Adenocarcinoma of ovary
. Adenocarcinoma of vagina
105) A 24-year-old female comes to the physician because of increasing facial acne and recent menstrual irregularities. She has no significant past medical history and she takes no medications. She does not use tobacco, alcohol or drugs. She weighs 170 lb (77 Kg) and is 62 in (155cm) tall. Physical examination shows moderate acne on her face and prominent hair on the upper lip. For which of the following conditions is she at greater risk than the general population?
. Ovarian cancer .
Breast cancer .
. Endometriosis .
Endometrial carcinoma
Adrenal carcinoma
106) You have a 32-year-old G1P0 patient who has undergone a routine obstetrical ultrasound screening at 20 weeks of gestation. The patient phones you immediately following the ultrasound because during the procedure the ultrasonographer commented that she noted several small fibroid tumors in the patient’s uterus. As this is the patient’s first pregnancy, she is concerned regarding the possible effects that the fibroid tumors may have on the outcome of her pregnancy. As her obstetrician, which of the following should you tell her?
Enlargement of the fibroids with subsequent necrosis and degeneration during pregnancy is common.
. Many women have fibroid tumors, but most fibroids are asymptomatic during pregnancy.
Progression to leiomyosarcoma is more common in pregnancy attributed to the hormonal effects of the pregnancy.
Preterm labor occurs frequently, even in women with asymptomatic fibroid tumors.
She will have to have a cesarean delivery because the fibroid tumors will obstruct the birth canal.
107) A 58-year-old Caucasian woman comes in to your office for advice regarding her risk factors for developing osteoporosis. She is 5ft 1 in tall and weighs 195 lb. She stopped having periods at age 49. She is healthy but smokes one pack of cigarettes per day. She does not take any medications. She has never taken hormone replacement for menopause. Her mother died at age 71 after she suffered a spontaneous hip fracture. Which of the following will have the least effect on this patient’s risk for developing osteoporosis?
Her family history.
. Her race
Her history of smoking cigarettes
Her menopause status .
Her obesity
108) While evaluating a 30-year-old woman for infertility, you diagnose a bicornuate uterus. You explain that additional testing is necessary because of the woman’s increased risk of congenital anomalies in which organ system?
. Skeletal
. Hematopoietic
. Urinary
. Central nervous
. Tracheoesophageal
109) A 25-year-old primiparous woman comes to your office 12 weeks after vaginal delivery of a healthy female baby. She has not had a menstrual period since delivery. She is nursing, and is using barrier methods for contraception. Examination shows no abnormalities. Which of the following is the most likely mechanism for this patient's amenorrhea?
. Inhibitory effect on FSH and LH by placental estrogens
. Inhibitory effect on GnRH by prolactin
. Suppression of endometrial proliferation by oxytocin
. Suppression of ovulation by human placental lactogen
Physiologic postpartum endometrial atrophy
110) A 20-year-old G0 and her partner, a 20-year-old man, present for counseling for sexual dysfunction. Prior to their relationship, neither had been sexually active. Both deny any medical problems. In medical experience, which type of male or female sexual dysfunction has the lowest cure rate?
Premature ejaculation .
. Vaginismus
. Primary impotence
. Secondary impotence
Female orgasmic dysfunction
111) A 28-year-old G3P3 presents to your office for contraceptive counseling. She denies any medical problems or sexually transmitted diseases. You counsel her on the risks and benefits of all contraceptive methods. Which of the following is the most common form of contraception used by reproductive-age women in the United States?
Pills
. Condom
. Diaphragm
. Intrauterine device (IUD)
. Permanent sterilization
112) A 20-year-old woman presents to your office for her well-woman examination. She has recently become sexually active and desires an effective contraceptive method. She has no medical problems, but family history is significant for breast cancer in a maternal aunt at the age of 42. She is worried about getting cancer from taking birth control pills. You discuss with her the risks and benefits of contraceptive pills. You tell her that which of the following neoplasms has been associated with the use of oral contraceptives?
Breast cancer .
. Ovarian cancer
. Endometrial cancer
. Hepatic cancer
Hepatic adenoma
113) A 39-year-old G3P3 presents for her postpartum examination and desires a long-term contraceptive method, but is unsure if she wants sterilization. She has been happily married for 15 years and denies any sexually transmitted diseases. Her past medical history is significant for mild hypertension, for which she takes a low-dose diuretic. She is considering an intrauterine device and wants to know how it works. Which of the following is the best explanation for the mechanism of the action of the intrauterine device (IUD)?
Hyperperistalsis of the fallopian tubes accelerates oocyte transport and prevents fertilization.
. A subacute or chronic bacterial endometritis interferes with implantation
Premature endometrial sloughing associated with menorrhagia causes early abortion.
. A sterile inflammatory response of the endometrium prevents implantation
. Cervical mucus is rendered impenetrable to migrating sperm
114) A 14-year-old girl is brought to the physician's office because of irregular menstrual periods. She had her menarche at age 13, and since then her periods have been irregular with the cycles varying from 3 to 6 weeks. She has no other symptoms. Physical examination is unremarkable. She has age appropriate secondary sexual characteristics. A urine pregnancy test is negative. Serum prolactin and thyroid stimulating hormone levels are normal. Administration of micronized oral progesterone results in withdrawal bleeding in 3 days. Which of the following most likely explains her irregular periods?
. Marked estrogen deficiency . .
. Insufficient gonadotropin secretion
. Excess LH secretion
Marked androgen excess
Uterine adhesions
115) A 20-year-old woman presents to your office for a well-woman examination. She has been sexually active with one male partner for the past year. She has not achieved orgasm with her partner. On further questioning, she has never achieved orgasm with other partners or with masturbation or the use of a vibrator. Which of the following statements is true regarding her condition?
It is unrelated to partner behavior
The influence of orthodox religious beliefs is still of major etiologic significance
It is unrelated to partner’s sexual performance
. It is not associated with a history of rape
. It always has an underlying physical etiology
116) A 48-year-old woman presents to your office with the complaint of vaginal dryness during intercourse. She denies any medical problems or prior surgeries and does not take any medications. She still has regular menstrual cycles every 28 days. She denies any sexually transmitted diseases. She describes her sexual relationship with her husband as satisfying. Her physical examination is normal. Components of the natural lubrication produced by the female during sexual arousal and intercourse include which of the following?
. Fluid from Skene glandsds . .
. Mucus produced by endocervical glands
Viscous fluid from Bartholin glands
. Transudate-like material from the vaginal walls
Uterotubal fluid
117) A wealthy American executive donates five million dollars for the prevention of intrauterine growth restriction in the local county. Spending this money on which of the following programs would prevent the greatest number of cases of fetal growth restriction (FGR) in the population?
. Alcoholic anonymous
. Smoking cessation
. Malnutrition prevention
Hypertension control
Infection control
118) A 33-year-old woman comes to the physician because she has not had a menstrual period for 8 months. She had menarche at the age of 12 and, after a few years of irregular menses, has since had normal monthly menses. She has no medical problems and takes no medications. Examination reveals a normal-appearing female with no abnormalities noted. Urine human chorionic gonadotropin (hCG) is negative. Serum thyroid stimulating hormone (TSH) and prolactin are also normal. The patient is given a 10-day course of medroxyprogesterone acetate. Upon completing the 10 days, she has a heavy menstrual period. This patient's withdrawal bleeding in response to the progesterone provides good evidence for which of the following?
. Asherman syndrome.
. Endogenous estrogen production
Endometrial carcinoma
. Menopause
. Pregnancy
{"name":"Basic USMLD Gyneco", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"1) A 29-year-old Caucasian primigravida patient is 20 weeks pregnant with twins. She found out today on her routine ultrasound for fetal anatomy that she is carrying two boys. In this patient’s case, which of the following statements about twinning is true?, 2) A 24-year-old primigravida with twins presents for routine ultrasonography at 20 weeks gestation. Based on the ultrasound findings, the patient is diagnosed with dizygotic twins. Which of the following is true regarding the membranes and placentas of dizygotic twins?, 3) After delivery of a term infant with Apgar scores of 2 at 1 minute and 7 at 5 minutes, you ask that umbilical cord blood be collected for pH. The umbilical arteries carry which of the following?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
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